Emotional exhaustion among anesthesia providers at a tertiary care center assessed using the MBI burnout survey

Refocusing on work-based hazards for the anaesthesiologist in a post-pandemic era

The coronavirus pandemic has raised public awareness of one of the many hazards that healthcare workers face daily: exposure to harmful pathogens. The anaesthesia workplace encompasses the operating room, interventional radiology suite, and other sites that contain many other potential occupational and environmental hazards. This review article highlights the work-based hazards that anaesthesiologists and other clinicians may encounter in the anaesthesia workplace: ergonomic design, physical, chemical, fire, biological, or psychological hazards. As the anaesthesia work environment enters a post-COVID-19 pandemic phase, anaesthesiologists will do well to review and consider these hazards. The current review includes proposed solutions to some hazards and identifies opportunities for future research.

COVID-19 pandemic burnout in an Italian sample of anaesthesiologists: coping strategies, resilience and the capability of tolerating the uncertainty as preventing factors

The present study aims to explore the prevalence of burnout characteristics and their association with resilience, coping strategies, and the intolerance of uncertainty dimensions. It also aims to explore the predictive effect of these variables on burnout dimensions, separately. Through the SurveyMonkey platform, 1,009 anaesthesiologists completed the Maslach Burnout Inventory (MBI), Resilience Scale, Intolerance of Uncertainty Scale Short Form (IU), and the Coping Inventory for Stressful Situations (CISS). According to the MBI cut-off, 39.7% and 25.8% of participants scored high in Emotional Exhaustion and Depersonalization, respectively, and 44.2% scored low in Personal Accomplishment. Several significant correlations between burnout dimensions and resilience, coping strategies, and the intolerance of uncertainty emerged. Regarding the linear regression models tested, coping strategies, resilience, and age showed a significant predictive effect on all three of the burnout dimensions. In conclusion, the results showed that individual levels of resilience and one's ability to tolerate uncertainty and task-oriented coping strategies represent significant factors for lower burnout levels in Italian anaesthesiologists during COVID-19 pandemic. These findings highlight the importance of intervention aimed at promoting useful coping strategies and enhancing resilience among healthcare workers.

Comparison of the burnout among medical residents before and during the pandemic

OBJECTIVE

This study aims to compare the level of burnout syndrome in medical residents before and during the COVID-19 pandemic and identify potential risk factors.

METHODS

This cross-sectional study was conducted on medical residents from three different university hospitals in Turkey in March 2021, one year after the pandemic hit Turkey. Burnout is measured by the Maslach Burnout Inventory which assesses three dimensions of it: emotional exhaustion, depersonalization, and personal accomplishment. Collected data were combined and compared with data from a previous study which was held in the same hospitals in December 2019, three months before the pandemic.

RESULTS

412 medical residents from three universities participated. The mean age was 27.8 ± 2.4 and half of them were female. Compared to pre-pandemic levels, no significant differences in emotional exhaustion (pre:19.0 ± 7.6 post:18.8 ± 7.8), depersonalization (pre:7.3 ± 4.3 post:7.2 ± 4.4), and personal accomplishment (pre:20.8 ± 5.1 post:21.1 ± 5) scores were observed one year after pandemic. Adjusting for confounders, multiple linear regression models indicated that who are female, are in surgical specialty, have vulnerable cohabitant, and have more night shifts faces higher emotional exhaustion. Depersonalisation is higher among who spent more years in residency, have more night shifts, or COVID-19 outpatient duty. Females and those who have vulnerable cohabitant has lower levels of Personal Achievement.

CONCLUSION

This study does not support the hypothesis that pandemic increases the burnout levels. Yet it identifies a couple of pandemic related factors that are associated with burnout and confirming the association of several previously known factors.

Association of burnout and intention-to-leave the profession with work environment: A nationwide cross-sectional study among Belgian intensive care nurses after two years of pandemic

BACKGROUND

Intensive care unit (ICU) nurses are at an increased risk of burnout and may have an intention-to-leave their jobs. The COVID-19 pandemic may increase this risk.

OBJECTIVE

The objective of this study was to describe the prevalence of burnout risk and intention-to-leave the job and nursing profession among ICU nurses and to analyse the relationships between these variables and the work environment after two years of the COVID-19 pandemic.

DESIGN

A national cross-sectional survey of all nurses working in Belgian ICUs was conducted between December 2021 and January 2022 during the 4th and 5th waves of the COVID-19 pandemic in Belgium. The Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to measure the work environment, intention-to-leave the hospital and/or the profession was assessed. The risk of burnout was assessed using the Maslach Burnout Inventory scale including emotional exhaustion, depersonalisation, and reduced personal accomplishment.

SETTING

Nurses in 78 out of 123 Belgian hospital sites with an ICU participated in the survey.

PARTICIPANTS

2321 out of 4851 nurses (47.8%) completed the entire online survey.

RESULTS

The median overall risk of burnout per hospital site (high risk in all three subdimensions) was 17.6% [P25: 10.0 - P75: 28.8] and the median proportion of nurses with a high risk in at least one subdimension of burnout in Belgian ICUs was 71.6% [56.7-82.7]. A median of 42.9% [32.1-57.1] of ICU nurses stated that they intended-to-leave the job and 23.8% [15.4-36.8] stated an intent-to-leave the profession. The median overall score of agreement with the presence of positive aspects in the work environment was 49.0% [44.8-55.8]. Overall, nurses working in the top 25% of best-performing hospital sites with regard to work environment had a statistically significant lower risk of burnout and intention-to-leave the job and profession compared to those in the lowest performing 25% of hospital sites. Patient-to-nurse ratio in the worst performing quartile was associated with a higher risk for emotional exhaustion (OR = 1.53, 95% CI:1.04-2.26) and depersonalisation (OR = 1.48, 95% CI:1.03-2.13) and intention-to-leave the job (OR = 1.46, 95% CI:1.03-2.05).

CONCLUSIONS

In this study, a high prevalence of burnout risk and intention-to-leave the job and nursing profession was observed after two years of the COVID-19 pandemic. Nevertheless, there was substantial variation across hospital sites which was associated with the quality of the work environment.

TWEETABLE ABSTRACT

"Burnout & intention to leave was high for Belgian ICU nurses after 2 years of COVID, but wellbeing was better with high quality work environments and more favourable patient to nurse ratios".

Neglecting physician desires to teach at an academic medical facility: A mixed method investigation of the consequences

PURPOSE

Recent findings have suggested that physicians who spend more time participating in their most meaningful job activities (e.g. teaching) are less likely to experience burnout. The current study aimed to expound upon this finding, focusing specifically on the role of teaching in promoting meaning and preventing burnout.

METHOD

A total of 428 physicians at a large academic healthcare institution completed an online survey that included measures of burnout and other relevant variables. In the second part of this study, 20 physicians participated in interviews with the aim of expounding upon and contextualizing the findings from Part 1.

RESULTS

Results from Part 1 suggested that although meaningfulness derived from teaching was associated with reduced burnout, this association was only true for those who indicated that clinical teaching was among the most meaningful parts of being a physician. In addition, physicians were less likely to spend time working on their most meaningful job activity when it was teaching. Part 2 illustrated why teaching in the clinical environment can be so meaningful and protective against burnout.

CONCLUSIONS

Many physicians are unable to teach due to the increasing demands of medical institutions, which may contribute to the increasing levels of burnout in healthcare providers.

Burnout in anaesthesiology residents: A systematic review of its prevalence and stressors

BACKGROUND

Burnout is an occupational hazard precipitated by chronic exposure to excessive work-related stress. It can have negative impacts on the health and safety of patients and clinicians. Anaesthesiologists are at a high risk of burnout; anaesthetic residents especially may experience higher levels of stress as a result of training requirements and postgraduate examinations. However, the scale of burnout among anaesthesiology residents is not well evaluated.

OBJECTIVES

To determine the prevalence of burnout and identify risk factors contributing to it among anaesthesiology residents worldwide and evaluate preventive strategies at institutional and departmental levels.

DESIGN

A systematic review without meta-analysis.

DATA SOURCES

We searched PubMed, Embase, Scopus and PsycInfo for English language articles published up to 24 May 2021.

ELIGIBILITY CRITERIA

The inclusion criteria for qualitative analysis were a reported burnout prevalence in anaesthesiology residents and the use of an assessment tool. Exclusion criteria were reviews/meta-analyses/correspondence, non-English articles, articles without anaesthesiology residents and lacking information on burnout prevalence and metrics for assessment.

RESULTS

Twelve studies met the inclusion criteria; seven studies utilised the 22-item Maslach Burnout Inventory Human Services Survey (MBI-HSS) and five utilised the abbreviated Maslach Burnout Inventory (aMBI). The reported burnout prevalence among anaesthesiology residents varied between 2.7 and 67.0% (median = 24.7%). Differences in burnout criteria contributed significantly to methodological heterogeneity. Factors predisposing to burnout included long working hours, poor workplace relationships, professional examinations and adverse clinical events. Protected rest time and restricted work hours were identified as effective strategies to prevent burnout. Other preventive strategies include mindfulness and resilience courses, as well as departmental initiatives such as exercise.

CONCLUSION

Burnout is common amongst anaesthesiology residents. Standardised tools and diagnostic criteria are needed to distinguish methodological heterogeneity from true heterogeneity in study populations. Interventions have been proposed to improve management strategies to minimise burnout anaesthesiology residents.

PROSPERO REFERENCE

CRD42019140472.

Impaired psychological well-being of healthcare workers in a German department of anesthesiology is independent of immediate SARS-CoV-2 exposure - a longitudinal observational study

Background: The study aimed to assess the mental well-being of healthcare professionals at a German department of anesthesiology and critical care with a specialized ICU for treatment of COVID-19 patients during the first two peaks of the 2020 pandemic, and identifying risk and protective factors.

Methods: A single-center longitudinal, online-based survey was conducted in healthcare workers from a department of anesthesiology and critical care in Bavaria, the most affected federal state in Germany at the time of assessment. Validated scores for depression, anxiety, somatic disorders, burnout, resilience, and self-management were used and complemented by questions about perceived COVID-19-related stressors. In parallel, patient characteristics in the ICU were collected.

Results: 24 and 23 critically ill COVID-19 patients were treated during both observation periods in April/May and November/December 2020, respectively. 87.5% and 78.2% of patients had moderate to severe acute respiratory distress syndrome. From March 6, 2020 onwards, the hospital had switched to a command and control-based hospital incident command system (HICS) and increased work forces. Point prevalence of depression-like symptoms (13.6% and 12.8%) and burnout (21.6% and 17.4%) in the department’s healthcare professionals was high. Exposure to SARS-CoV-2 did not increase psychological burden. Consequences of the lockdown were rated as highly distressing by a majority of all ICU personnel. High self-reported trait resilience was protective against signs of depression, generalized anxiety, and burnout.

Conclusions: During the pandemic, healthcare professionals have been suffering from increased psychological distress compared to reference data for both the general population and ICU personnel. General effects of the lockdown appear more relevant than actual COVID-19 patient contact. High trait resilience has a protective effect, yet vulnerable individuals may require specific support. Prevention against potential after effects of the lockdown, and in particular measures allowing to avoid another lockdown, appear warranted.

The prevalence of burnout syndrome and its association with adherence to safety and practice standards among anesthetists working in Ethiopia

Background

Burnout amongst healthcare professionals is a serious challenge affecting health care practice and quality of care. The ongoing pandemic has highlighted this on a global level. This study aimed to determine the prevalence of burnout syndrome and its association with adherence to safety and practice standards among non-physician anesthetists in Ethiopia.

Methods

A cross-sectional survey was conducted amongst non-physician anesthetists throughout Ethiopia in January 2020 utilizing an online validated questionnaire containing sociodemographic characteristics, symptoms of burnout using the 22 items of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) scale, 10 questions designed to evaluate the best practice of providers, and 7 questions evaluating self-reported errors. The MBI-HSS questions assessed depersonalization, emotional exhaustion, and personal accomplishment. A high level of burnout was defined as a respondent with an emotional exhaustion score ≥27, a depersonalization score ≥10, and a personal accomplishment score ≤33 in the MBI-HSS subscales. Bi-variable and multivariable logistic regression were used to identify factors associated with burnout.

Results

Out of a total of 650 anesthetists approached, 400 responded, a response rate of 61.5%. High levels of burnout were identified in 17.3% of Ethiopian anesthesia providers. Significant burnout scores were found in academic anesthetists (p = 0.01), and were associated with less years of anesthesia experience (p < 0.001), consuming >5 alcoholic drinks per week (p = 0.02), and parenthood (p = 0.01).

Conclusion

We found that non physician anesthetists working in Ethiopia is suffering by high levels of burnout. The problem is alarming in those working at academic environments and less experienced.

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Burnout were identified in 17.3% of Ethiopian anesthesia providers.

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Significant burnout scores were found in academic anesthetists.

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Anesthetists who have high burnout score committed medical malpractice.

Assessment of burnout levels among anesthesiologists and anesthesiology technicians in Kosovo: A cross-sectional study

BACKGROUND

Anaesthesiology practitioners experience extraordinary pressure and stress in their daily work.

OBJECTIVE

The purpose of this research is to assess the occupational factors and burnout syndrome among anaesthesiologists and anaesthesiology technicians in Kosovo.

METHODS

This is a cross-sectional study carried out on a sample of 154 (out of 220) anaesthesiologists and anaesthesiology technicians in Kosovo. We collected the data using the Maslach Burnout Inventory and Occupational Role Stressors Scale.

RESULTS

The mean ± SD age of the study sample was 42.5 ± 8.7 years, and 57% of them were working more than 40 h per week. A high level of burnout in terms of depersonalization (DP) was found among 48 of anaesthesiologists and anaesthesiology technicians, 26 had high level of emotional exhaustion (EE). EE and DP showed significant positive correlation with work overload, managerial responsibility role, and overall occupational stress (p < 0.05). Female anaesthesiologists and anaesthesiology technicians showed higher score of personal achievement (PA) compared to males (p < 0.05).

CONCLUSION

Approximately one-third of Kosovar anaesthesiologists and anaesthesiology technicians showed high level of burnout and it is rising as work overload and the role of managerial responsibility increases. Increasing the number of employed anaesthesiologists and anaesthesiology technicians in health institutions in Kosovo will lead to a better workload distribution and lower burnout syndrome.

Prevalence of burnout risk and factors associated with burnout risk among ICU nurses during the COVID-19 outbreak in French speaking Belgium

OBJECTIVE

Burnout is a global work-related phenomenon. Intensive care unit (ICU) nurses are at risk of burnout and the COVID-19 pandemic may increase this risk. The objectives of this study were to assess the prevalence of burnout risk and identify risk factors among ICU nurses during the COVID-19 pandemic.

RESEARCH METHODOLOGY

Web-based survey performed during the first wave of the COVID-19 pandemic in French speaking Belgium.

MAIN OUTCOME MEASURES

Risk of burnout was assessed with the Maslach Burnout Inventory scale.

RESULTS

A total of 1135 ICU nurses responded to the questionnaire. The overall prevalence of burnout risk was 68%. A total of 29% of ICU nurses were at risk of depersonalisation (DP), 31% of reduced personal accomplishment (PA), and 38% of emotional exhaustion (EE). A 1:3 nurse-to-patient ratio increased the risk of EE (OR = 1.77, 95% CI: 1.07-2.95) and DP (OR = 1.38, 95% CI: 1.09-2.40). Those who reported having a higher perceived workload during the COVID-19 pandemic were at higher risk for all dimensions of burnout. Shortage of personal protective equipment increased the risk of EE (OR = 1.78, 95% CI: 1.35-3.34) and nurses who reported having symptoms of COVID-19 without being tested were at higher risk of EE (OR = 1.40, 95% CI: 1.68-1.87).

CONCLUSIONS

Two-thirds of ICU nurses were at risk of burnout and this risk was associated with their working conditions during the first wave of the COVID-19 pandemic. We recommend monitoring the risk of burnout and implementing interventions to prevent and manage it, taking into account the factors identified in this study.

Physician Burnout: Achieving Wellness for Providers and Patients

Purpose of Review

This review summarizes the history and scope of physician burnout, and explores recent advances in its understanding. With a particular focus on physicians who have completed their training, it also explores the present and future of interventions designed to alleviate the symptoms and sequelae of burnout.

Recent Findings

Nearly 50 years since first described, burnout continues to remain a pervasive issue within anesthesia and medicine as a whole. Recent work has continued to outline risk factors and specialty-specific prevalence, and explore individual and institutional interventions to prevent and treat symptoms.

Summary

Burnout continues to impact all who work in healthcare, at all levels of training. This review highlights recent advances in our understanding of the scope, causes, and management of burnout. In light of the current COVID-19 pandemic, we hope that the national and international focus on preventing and remediating burnout will continue to expand and strengthen.